Günay Saner

Association of Helicobacter pylori infection with gastroduodenal disease, epidemiologic factors and iron-deficiency anemia in Turkish children undergoing endoscopy, and impact on growth.

Background: The purpose of the present paper was to investigate the relationship between Helicobacter pylori infection and clinical symptomatology, breast‐feeding and socioeconomic level. The relationship between H. pylori and iron‐deficiency anemia (IDA) and the effect of H. pylori infection on growth were also investigated.

An educational intervention on promotion of breast feeding.

This study was designed to search for an effective method to promote exclusive breast feeding among Turkish city women delivering in hospitals. Four hundred and forty-two primiparae with uncomplicated deliveries and with healthy infants with birthweights of greater than 2500 g were exposed to a group educational session on breast feeding after birth, followed by one repeat session at home. Four hundred and ninety-nine women served as controls. All homes were visited monthly for 6 months by independent observers and data relevant to the feeding of the infants were collected. Weight measurements of 176 infants were taken at age 4 months. The study and control mothers were similar in sociodemographic characteristics which reflected a low socio-economic/educational background but relatively good housing conditions. Although significant differences in frequency of exclusive breast feeding were found between the study and control groups, the impact of the intervention was much lower than our expectations and short-lived. Type of feeding was not related to sex or birthweight of the infant, nor to maternal variables. Weight at age 4 months was within normal limits and similar in the study and control groups. It was concluded that lack of up-to-date information on infant feeding was the main obstacle to breast feeding in urban groups in Turkey, and that the impact of an educational intervention limited to the first week after delivery was lost within the first 2 months.

CagA positivity and its association with gastroduodenal disease in Turkish children undergoing endoscopic investigation

BackgroundCytotoxin-associated gene A (CagA) product is a bacterial virulence factor contributing to the pathogenicity of Helicobacter pylori (HP) infection in humans. Host factors, which vary in different countries, interact with bacterial factors to determine the disease state. Our objective was to investigate the frequency of CagA-positive HP strains and evaluate the contribution of CagA positivity to symptoms and development of mucosal lesions in HP-infected Turkish children.MethodsWe conducted a prospective clinical trial in 240 consecutive Turkish children undergoing endoscopy (110 girls, 130 boys; mean age, 8.7 ± 4.3 years). HP infection was diagnosed on the basis of a positive rapid urease test and histology of the mucosal specimens. HP IgG and CagA IgG antibodies were measured by enzyme-linked immunosorbent assay in HP-positive children.ResultsThe HP positivity rate was 50.4% in our study group (51 girls, 70 boys; mean age, 9.9 ± 3.9 years). CagA was positive in 74.4%. HP infection was less common in children with vomiting (25.9%, P < 0.05). CagA positivity was not associated with any clinical symptom. HP positivity was higher in children with duodenal ulcer (80% vs. 49.1%, P = 0.05); while CagA positivity was similar. Antral nodularity was strongly associated with HP positivity and CagA positivity (30.6% vs. 3.4% and 36.7% vs. 12.9%, respectively, P < 0.05). A negative association between CagA positivity and esophagitis was observed (20% vs. 76.7%, P < 0.05).ConclusionsCagA positivity is common in HP-infected Turkish children. Esophageal lesions are less common in children infected with CagA-positive strains. Although HP is associated with duodenal ulcer disease, CagA positivity does not seem to contribute to development of ulcers in children in our series.

Long-term outcome after sclerotherapy with or without a beta-blocker for variceal bleeding in children.

Background : Esophageal variceal bleedingis a life‐threatening complication of portal hypertension. Optimal treatmentfor the prophylaxis of variceal rebleeding in children has not yetbeen determined. In the present study, we aimed to compare the long‐termefficacy of endoscopic sclerotherapy with or without oral beta‐blockertherapy in the secondary prophylaxis of variceal bleeding.

Blood Lead Levels in School Children

The aim of this study was to determine the risk factors associated with high lead levels in school children. To that end a questionnaire was prepared to gather information about demographic and socio-economic characteristics of the children. Blood lead concentrations were obtained from capillary blood taken from 760 children at 13 schools in Istanbul and determined by atomic absorption spectrophotometry. The blood lead level ranged between 4.0 and 23μg· dL−1. The mean and the median values of the blood lead were 8.4μg·dL−1. Some 91.2% of the children (693) had blood lead levels ≤10μg·dL−1. Only 5 (0.6%) had blood lead levels over 15μg·dL−1. One child had a blood lead level above 20μg·dL−1. Household exposure to smoking, attending school near a main street and middle and upper-middle-class socio-economic status were found to be the most important risk factors for a high blood lead level. Children attending schools that were nearest to a main road exhibited higher blood lead levels than children in schools further from a main road. Our findings support the public health recommendations that children should not have household exposure to smoking, schools should not be located near main streets and unleaded gasoline use should be promoted.

Longitudinal Analyses of Blood-Lead Levels and Risk Factors for Lead Poisoning in Healthy Children under Two Years of Age

This study aimed to determine the risk factors for lead poisoning of infants living in Istanbul. It was a longitudinal study conducted between March 1998 and September 2000 at the “Well-Child Unit” based at the Istanbul Medical School. During the study period, a total of 242 newborns were registered and 220 of them met the eligibility criteria. The families of 199 infants gave consent for this study. At the end of two years, 131 infants had completed the study. Blood samples were collected when the infants were aged 1, 6, 12, and 24 months. All samples were assessed using atomic absorption spectrophotometry. Blood-lead levels (BLL) increased with age. The maximum BLL was observed at 24 months. There was no infant with a BLL above 10 μgdL1 at one-month of age but this figure was exceeded for 0.5% of the cohort at 6 months, 1.1% at 12 months and 11.5% at 24 months. Children who were given herbal tea and exposed to tobacco smoke, lived in centrally heated homes, and whose fathers were manual workers had significantly higher BLL. The study identified herbal tea, exposure to dust, soil, paint and metal construction debris containing lead and living in an environment where people smoked as factors that put children under two years of age at increased risk of “elevated” BLL.